Dysphagia megalatriensis, also known as cardiovascular dysphagia or cardiac dysphagia, is an impairment of swallowing due to oesophageal compression from a dilated left atrium.
Presentation is generally with mild dysphagia, although a minority of patients will have dysphagia severe enough to develop weight loss and nutritional imbalances 1-5. The most serious complication is development of an atrio-oesophageal fistula resulting in fatal haematemesis 2.
Oesophageal compression and resultant dysphagia secondary to left atrial enlargement is considered to be very uncommon 1,3,5. This is likely because when the left atrium enlarges posteriorly, the oesophagus is usually able to 'slip' to either side of the vertebral body and thus, avoid being compressed until the left atrium is very large 3.
Due to the rarity of this condition, it is important to exclude other commoner causes of dysphagia before settling on this diagnosis 5.
Chest radiographs demonstrate features consistent with left atrial enlargement 1-5.
Barium swallow or oesophagography of the oesophagus reveals delayed transit and demonstrates an indentation in the oesophageal wall by the dilated left atrium 1-4.
These cross-sectional modalities will allow the best visualisation of a dilated left atrium compressing the oesophagus 4,5.
Treatment and prognosis
Treatment is necessary only if symptomatic, and generally patients will require a nasogastic tube for enteric feeding 1,4. Management of the underlying cause of left atrial enlargement (e.g. mitral stenosis) is also pertinent.
- 1. Le Roux BT, Williams MA. Dysphagia megalatriensis. Thorax. 24 (5): 603. doi:10.1136/thx.24.5.603 - Pubmed
- 2. Behl PR, Holden MP. Mitral valve disease and dysphagia. European heart journal. 5 (11): 919-23. Pubmed
- 3. Desanctis RW, Dean DC, Bland EF. Extreme Left Atrial Enlargement. Circulation. 29 (1): 14. doi:10.1161/01.CIR.29.1.14 - Pubmed
- 4. Heng JS, Elghamaz A. Atrial enlargement associated with non-valvular atrial fibrillation: an unusual cause of dysphagia and weight loss. BMJ Case Reports. 2015: bcr2014209213. doi:10.1136/bcr-2014-209213 - Pubmed
- 5. Mönkemüller K, Feldmann K, Ulbricht LJ. Electronic image of the month. Cardiac dysphagia. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. 8 (4): e41-2. doi:10.1016/j.cgh.2009.12.014 - Pubmed
- 6. Haziz SRA, Bickle I, Chong VH. Dysphagia aortica: a rare cause of dysphagia. BMJ Case Reports. 2015: bcr2015211726. doi:10.1136/bcr-2015-211726 - Pubmed
- 7. Hudzik B, Gąsior M. IMAGES IN CLINICAL MEDICINE. Dysphagia Lusoria. The New England journal of medicine. 375 (4): e4. doi:10.1056/NEJMicm1600874 - Pubmed